Healthcare Provider Details

I. General information

NPI: 1619894433
Provider Name (Legal Business Name): EDUARDO PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1887 MONTEREY HWY STE 225
SAN JOSE CA
95112-6192
US

IV. Provider business mailing address

PO BOX 740780
ATLANTA GA
30374-0780
US

V. Phone/Fax

Practice location:
  • Phone: 669-235-3344
  • Fax:
Mailing address:
  • Phone: 855-223-7123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number46-1305562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: